Revenue Cycle Management 4 Flashcards
6 cards from real CHAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Revenue Cycle Management 4 flashcards as text
What is the primary purpose of a remittance advice (RA) in the revenue cycle?
Answer: To explain the payment determination made by a payer on a submitted claim
A remittance advice is a document sent by the payer alongside payment that details how each claim was adjudicated, including amounts paid, denied, or adjusted. It allows the provider to reconcile payments and identify discrepancies.
Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is rendered?
Answer: Days in accounts receivable (AR)
Days in accounts receivable (AR) is a key revenue cycle performance indicator that tracks how long it takes, on average, to collect payment from the date of service. A lower number generally indicates a healthier revenue cycle.
During the revenue cycle, what is the role of coordination of benefits (COB)?
Answer: To determine which payer is primary when a patient has multiple insurance plans
Coordination of benefits (COB) is the process of determining the order in which multiple insurance plans pay a claim. The primary payer pays first, and the secondary payer may cover remaining eligible balances, preventing overpayment.
What does a contractual adjustment represent in healthcare billing?
Answer: The difference between a provider's billed charges and the payer's allowed amount
A contractual adjustment is the amount written off because the provider has an agreement (contract) with the payer to accept a negotiated rate. The provider cannot bill the patient for this difference, which is known as balance billing prohibition.
Which revenue cycle function is primarily responsible for verifying a patient's insurance eligibility and benefits prior to a service date?
Answer: Pre-registration and access services
Pre-registration and access services staff verify insurance eligibility and benefits before the patient arrives, ensuring accurate insurance information is on file. This reduces claim denials caused by coverage issues and improves point-of-service collections.
What is the significance of a timely filing limit in the revenue cycle?
Answer: It is the maximum period within which a claim must be submitted to a payer after the date of service
Payers set timely filing limits that define the deadline for submitting a claim after the date of service. Claims submitted after this deadline are typically denied and cannot be resubmitted, resulting in lost revenue for the organization.